Continuing Education Column Differential Diagnosis of Head and Neck Mass Lesions Hang Seok Chang, M.D. Department of General Surgery Yonsei University College of Medicine Yongdong Severance Hospital E mail : surghsc@yumc.yonsei.ac.kr Abstract For the differential diagnosis of head and neck mass lesions, the age and presenting locations should be the primary considerations. The characteristic patterns of age and site predilection allow a diagnostic work up and treatment plans for the patients with head and neck mass lesions. In children and young adults, the underlying causes are; inflammatory, congenital and developmental, and neoplastic masses in decreasing frequency. By contrast, neoplastic diseases are most frequent in the elderly. Because of the characteristic lymphatic spread patterns of head and neck diseases, the location of the mass in the cervical lymphatic nodal chain may be the key for the identification and differential diagnosis of the primary disease site. Besides, the evaluation of specific historical and physical findings is mandatory for the accurate diagnosis. When the signs of inflammation are associated, conservative treatment and observation is first considered. On the other hand, for persistent or progressively enlarging masses and those with suspicious findings of malignancy, surgical intervention should be considered. Keywords : Head and neck masses; Differential Diagnosis; Age group; Location 239
Continuing Education Column Classification of neck masses Inflammatory neck masses Abscess Cervical lymphadenitis Bacterial Granulomatous: tuberculosis, actinomycosis, sarcoidosis Viral: infectious mononucleosis Non inflammatory neck masses Congenital thyroglossal duct anomalies branchiogenic anomalies lymphangioma dermoid cyst, sebaceous cyst hemangioma cervical thymic arrest teratoma laryngocele Neoplastic Benign tumors: thyroid tumors, salivary gland tumors, paragangliomas, carotid body tumors Malignant tumors Primary: from thyroid, salivary glands, cervical soft tissue Metastatic: from original sites head and neck: 60~70% other than head and neck: 10~20% no primary site found: 5~10% Lymphoreticular neoplasm Traumatic Distribution of disease categories by age (in order to frequency) 15 years 16~40 years 41 years Inflammatory Inflammatory Neoplastic Congenital Congenital Malignant Neoplastic Neoplastic Benign Malignant Benign Inflammatory Benign Malignant Congenital Trauma Trauma Trauma 240
A Clinical description of the location in neck Classification of neck nodes group in neck: A) Classification of MD Anderson Cancer Center B) Classification of Memorial Sloan Kettering Cancer Center B 241
Continuing Education Column Distribution of disease categories by location Location Midline and Anterior Neck Anterior Triangle Posterior Triangle Congenital / developmental Thyroglossal duct cyst Branchial cyst Lymphangioma Dermoid Thymic cyst Laryngocele Inflammatory Adenitis Adenitis Adenitis Bacterial Bacterial Bacterial Viral Viral Viral Granulomatous Granulomatous Granulomatous Sialadenitis Parotid Submaxillary Thorotrast Granuloma Neoplastic Thyroid Lymphoma Piimary vascular Lymphoma Lymphoma Metastatic Carotid body Metastatic Upper jugular Glomus Superior Oropharynx Hemangioma Nasopharynx Oral cavity Neurogenic Scalp Lower Jugular Neurilemoma Supraclavicular Hypopharynx Salivary Breast Larynx Parotid Lung Submaxillary Submaxillary Gastrointestinal Oral cavity Genitourinary Nasal Gynecological Face Trauma Sternocleidomastoid False aneurysm Neuroma Hematoma / fibroma 242
Location of primary tumor associated with lymph node metastasis in neck Location Primary sites Preauricular Ear, scalp, skin Submental Lip, skin, anterior oral cavity Submaxillary triangle Submandibular gland, oral cavity, skin, lip, paranasal sinus External jugular Parotid gland, skin, ear Suboccipital Scalp, postauricular skin Jugulodigastric Oral cavity, oropharynx, paranasal sinus, nasopharynx, hypopharynx, larynx, parotid gland Midjugular Hypopharynx, larynx, thyroid, oral cavity, oropharynx Lower jugular Thyroid, larynx, cervical esophagus Upper posterior Nasopharynx, paranasal sinus, oropha rynx, sin, scalp Prelaryngeal Larynx, thyroid Supracalvicular Thyroid, cervical esophagus, infracla vicular primary 243
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